Recommendations on RBC Transfusion in Infants and Children With Acquired and Congenital Heart Disease From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative

Cholette, Jill J.M.; Willems, Ariane; Valentine, Stacey S.L.; Bateman, Scot S.T.; Schwartz, Steven S.

doi:10.1097/pcc.0000000000001603

Cited by 64 publications

(82 citation statements)

References 90 publications

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“…Metabolic rate and baseline oxygen demands may be greater than in adults. However, otherwise healthy pediatric age patients (excluding neonates for which there is a paucity of data) may be more tolerant of severe anemia than critically ill children or those with pre‐existing medical conditions with compromised cardiopulmonary function, and may tolerate lower hemoglobin transfusion thresholds, particularly when anemia develops slowly …”

Section: Standard 13 Guidence Patient Blood Management For Pediatricmentioning

confidence: 99%

“…Current expert consensus guidelines recommend taking into consideration the individual patient's clinical status along with an optimum hemoglobin target. In general, recommendations for pediatric patients (excluding neonates) suggests that a hemoglobin threshold transfusion target of 7 g/dL (70 g/L) is appropriate in a hemodynamically stable well compensated patient and that, , in general, given a hemoglobin concentration of >9 g/dL (90 g/L), red blood transfusion is unnecessary and inappropriate . Neonates, are physiologically quite distinct from infants and young children and require a specific and different set of hemoglobin thresholds and transfusion guidelines .…”

Section: Standard 13 Guidence Patient Blood Management For Pediatricmentioning

confidence: 99%

“…However, otherwise healthy pediatric age patients (excluding neonates for which there is a paucity of data) may be more tolerant of severe anemia than critically ill children or those with pre-existing medical conditions with compromised cardiopulmonary function, and may tolerate lower hemoglobin transfusion thresholds, particularly when anemia develops slowly. 2,5,14,19,25 Preoperative anemia is prevalent with~40% incidence in children worldwide and a 15%-20% prevalence in children in industrialized countries; 1% having severe anemia. The main etiology is iron deficiency.…”

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confidence: 99%

“…In general, recommendations for pediatric patients (excluding neonates) suggests that a hemoglobin threshold transfusion target of 7 g/dL (70 g/L) is appropriate in a hemodynamically stable well compensated patient and that, in general, given a hemoglobin concentration of >9 g/dL (90 g/L), red blood transfusion is unnecessary and inappropriate. 5,19,25,26,31,32 Neonates, are physiologically quite distinct from infants and young children and require a specific and different set of hemoglobin thresholds and transfusion guidelines. 8,18,20,33 This is confounded by the fact that they have varying hemoglobin levels and types, and potentially a limited ability to tolerate physiologic stress, and a weak immune response.…”

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confidence: 99%

“…23 Uniquely challenging settings are those of cardiopulmonary bypass, extracorporeal membrane oxygenation or exchange transfusion; situations analogous to a massive transfusion. 4,5 Due to the small blood volume of neonates and infants, multiple blood components are usually indicated. Prematurity and immaturity contribute to sub-optimal coagulation in many patients.…”

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confidence: 99%

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Society for the advancement of blood management administrative and clinical standards for patient blood management programs. 4th edition (pediatric version)

Goobie¹,

Gallagher²,

Gross

et al. 2019

Pediatric Anesthesia

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Summary Patient Blood Management is the timely application of evidence‐based medical and surgical concepts designed to maintain hemoglobin concentration, optimize hemostasis, and minimize blood loss to improve patient outcomes. Conceptually similar to a “bundle” strategy, it is designed to improve clinical care using comprehensive evidence‐based treatment strategies to manage patients with potential or ongoing critical bleeding, bleeding diathesis, critical anemia, and/ or a coagulopathy. Patient Blood Management includes multimodal strategies to screen, diagnose and properly treat anemia, coagulopathies and minimize bleeding, using goal‐directed therapy and leverages a patient's physiologic ability to adapt to anemia while definitive treatment is undertaken. Allogeneic blood component transfusion is one traditional therapeutic modality out of many for managing blood loss and anemia and, while it may be the best choice in certain situations, other effective and more appropriate options are available and should be used in conjunction or alone. Therefore, comprehensive Patient Blood Management is the new standard of care to prevent and manage anemia and optimize hemostasis and has been recommended by the World Health Organization, the American Society of Anesthesiologists, the European Society of Anaesthesiology and the Australian National Blood Authority. While there is a plethora of expert consensus and good practice guidelines published for blood component transfusion from multiple professional organizations and societies, there remains a need for more comprehensive and broader standards of patient medical management to proactively reduce the risk of exposure to allogeneic transfusions. In 2010, the Society for Advancement of Blood Management published the first comprehensive standards to address the administrative and clinical components of an effective, patient‐centered Patient Blood Management program. Recognizing the need to reduce inappropriate transfusions, some professional organizations have placed their emphasis on transfusion guidelines. In contrast, the focus of the Society for Advancement of Blood Management Standard is on the centrality of the patient and the full spectrum of therapeutic strategies needed to improve clinical outcomes in patients at risk for blood loss or anemia, thereby reducing avoidable transfusions as well. The Standards are meant not to replace, but to complement transfusion guidelines by more completely addressing the need for a multi‐modal clinical approach with the goal to improve patient outcomes. Compared to adult programs, Pediatric Patient Blood Management programs are currently not commonly accepted as standard of care for pediatric patients. This is partly due to the fact that, until recently, there was a paucity of robust evidence‐based literature and expert consensus guidelines on pediatric PBM. Managing pediatric bleeding and blood product transfusion presents a unique set of challenges. The main goal of transfusion is to correct or avoid imminent inadequate oxygen c...

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Section: Standard 13 Guidence Patient Blood Management For Pediatricmentioning

confidence: 99%

Section: Standard 13 Guidence Patient Blood Management For Pediatricmentioning

confidence: 99%

mentioning

confidence: 99%